Using Medications to Decrease the Risk for Breast Cancer in Women: Recommendations From the U.S. Preventive Services Task Force
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The full report is titled “Medications for Risk Reduction of Primary Breast Cancer in Women: U.S. Preventive Services Task Force Recommendation Statement.” It is in the 19 November 2013 issue of Annals of Internal Medicine (volume 159, pages 698-708). The author is V.A. Moyer, on behalf of the U.S. Preventive Services Task Force.

This article was published online first at www.annals.org on 24 September 2013.

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Who developed these recommendations?

The U.S. Preventive Services Task Force (USPSTF) developed these recommendations. The USPSTF is a group of physicians and other health care experts that makes recommendations about preventive health care.

What is the problem and what is known about it so far?

More than 39,600 American women will die of breast cancer in 2013. The strongest risk factors for breast cancer are older age, family history of breast or ovarian cancer (especially in a mother, sister, or daughter before age 50 years), previous breast biopsy (especially if results showed an abnormality called “atypical hyperplasia”), and extremely dense breast tissue. Chemoprevention is a strategy for reducing the risk for cancer by taking drugs. Some evidence indicates that tamoxifen and a similar drug, raloxifene, can prevent breast cancer in women who have never had the disease. However, these drugs also have adverse effects, including hot flashes, and they increase the risk for uterine cancer, cataracts, and blood clots. Women must weigh the potential benefits of chemoprevention for breast cancer against these risks. The USPSTF last issued recommendations on breast cancer chemoprevention in 2002.

How did the USPSTF develop these recommendations?

The USPSTF reviewed research published since 2002 to evaluate the benefits and harms of using medication to prevent breast cancer.

What did the authors find?

The USPSTF found evidence that tamoxifen or raloxifene can reduce the risk for certain types of breast cancer in postmenopausal women who are at increased risk for the disease. Tamoxifen seems to reduce risk more than raloxifene. Tamoxifen also reduces breast cancer risk in high-risk premenopausal women. For women who are not at increased risk, chemoprevention's benefits are no greater than small.

The harms of tamoxifen and raloxifene include hot flashes and blood clots. Tamoxifen, but not raloxifene, also increases the risk for uterine cancer, particularly in women older than 50 years who have a uterus. Tamoxifen may also increase the risk for cataracts.

What does the USPSTF recommend that patients and doctors do?

Women at low or average risk for breast cancer should not routinely use tamoxifen or raloxifene to prevent breast cancer.

Women with risk factors for breast cancer should discuss the potential benefits and harms of tamoxifen and raloxifene with their physicians. A woman is least likely to experience the adverse effects of chemoprevention if she is younger than 50 years, has no special risk for blood clots or stroke, and has no uterus. Physicians should offer chemoprevention to women at high risk for breast cancer and at low risk for blood clots.

What are the cautions related to these recommendations?

Available information is limited about the effectiveness of methods for estimating a woman's breast cancer risk and identifying candidates for chemoprevention.

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Using Medications to Decrease the Risk for Breast Cancer in Women: Recommendations From the U.S. Preventive Services Task Force. Ann Intern Med. 2013;159:I–28. doi: 10.7326/0003-4819-159-10-201311190-00717